Der Onkologe

, Volume 15, Issue 12, pp 1215–1222 | Cite as

Adjuvante Therapie des Kolonkarzinoms

Leitthema
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Zusammenfassung

Das Kolonkarzinom gehört zu den häufigsten Tumorentitäten und wird bei der Mehrheit der Patienten im lokalisierten Stadium diagnostiziert. Das Rezidivrisiko schwankt je nach Stadium zwischen 10 und 80%, kann aber bei Risikopatienten mit einer postoperativen Chemotherapie in relevantem Maße gesenkt werden. Im Stadium III ist die adjuvante Chemotherapie eindeutig indiziert, sofern keine Kontraindikationen vorliegen. Im Stadium II hat die Chemotherapie einen nur marginalen Effekt auf das rezidivfreie Überleben und wird daher nicht routinemäßig empfohlen. Bei Vorliegen von Risikofaktoren wie Perforation, unzureichender Anzahl untersuchter Lymphknoten etc. kann die Chemotherapie jedoch auch im Stadium II eine relevante Verbesserung bringen und sollte individuell mit den Patienten diskutiert werden. Es wird die Kombination aus Oxaliplatin plus 5-FU/Folinsäure (FOLFOX) empfohlen. Alternativ können auch orale Fluoropyrimidine als Monotherapie gegeben werden.

Neueste Daten lassen den Vorteil der adjuvanten Chemotherapie bei älteren Patienten fraglich erscheinen. Weiterhin konnte die erste Studie von Bevacizumab in der adjuvanten Situation nicht die gestellten Erwartungen erfüllen.

Schlüsselwörter

Kolonkarzinom Rezidivrisiko Adjuvante Chemotherapie FOLFOX Bevacizumab 

Adjuvant therapy in colon cancer

Abstract

Colon cancer is one of the leading cancer diseases in the Western world, with most patients having localized tumors upon their initial diagnosis. Adjuvant chemotherapy is clearly recommended for patients with Dukes C disease. In Dukes B colon cancer, chemotherapy has only marginal effects and is therefore not routinely recommended. However, in patients with risk factors such as insufficient lymph node removal, perforation, etc., chemotherapy might have more impact and should be individually discussed with the patient. Routinely, the combination of oxaliplatin plus 5FU/LV (FOLFOX) should be used. Oral fluoropyrimidines may be given alternatively.

Recent results questioned the benefit of adjuvant chemotherapy in elderly patients. Data on bevacizumab combined with FOLFOX did not meet the expectations and will be discussed in detail.

Keyword

Colon cancer Dukes C disease Adjuvant chemotherapy FOLFOX Bevacizumab 

Notes

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

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Copyright information

© Springer Medizin Verlag 2009

Authors and Affiliations

  1. 1. Onkologie, Hämatologie und Knochenmarktransplantation mit Sektion Pneumologie, Universitäres Cancer Center Hamburg – Hubertuswald TumorzentrumUniversitätsklinikum Hamburg-EppendorfHamburgDeutschland

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